2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008...

2008 NAPHSIS Annual MeetingCelebrating 75 Years of ExcellenceOrlando, FL June 1st – 5th, 2008

Publish or Perish: After 75 Years, Have State Compendiums of Vital

Statistics Outlived Their Usefulness?

Mark Flotowand Gary Morgan

Illinois Center for Health StatisticsIL Dept of Public Health

5 June, 2008Orlando, FL


And the answer is . . .

. . . “MAYBE”

. . . Failure to evolve is not an option

. . . for continued survival

“Publish or Perish . . .”

5 June, 2008


Past Evolution (IL examples)

1960 Characteristics:

- Thin (54 pages)- Typed; includes 9 pages of text- A marvel of duplication technology


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- Thicker (184 pages), thanks to modern data processing

- Mainframe-looking output, plus 14 pages of text

- A marvel of cut-and-paste technology


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- Phonebook thick (318 pages), thanks to really modern data processing

- PC-based output plus 47 pages of text, integrated with tables and graphs

- A marvel of Y2K survival


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Future Evolution . . .

. . . do we need to continue to print our annual compendiums??


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Publish? Perish the Thought . . .

The pros (and prose) of old school publishing:

- Excellent desktop reference- Libraries still love them- Portable and visual- A permanent record


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The cons (and complaints) of old school publishing:

- Expensive to print and distribute- S-l-o-w (layout, editorial review,

duplicating, binding, etc.)- Corrections and errata are continuous

issues


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The pros of Web publishing:- Cheap to produce and about nil to

distribute- Not a permanent record; can be

corrected, modified, replaced, deleted- Always quicker than printing (fewer

production steps)- Can add extra flash and features (e.g., a

hot-linked TOC)


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The cons of Web publishing:

- Needs to be monitored; generally not “set and forget” (a case of higher expectations and perpetual responsibility)

- In some cases, passing on costs and time of printing to consumer (i.e., collectively inefficient)

- Need PC, Internet access


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What do my users need? Typical questions for which they seek answers . . .

- I just need the (one) number of . . .- Tell/Give me everything you know/have

about . . .- How does my area compare to the state

on . . . ?


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What do my users need? Typical questions for which they seek answers (continued)

- What is the rank of X ? (e.g., leading causes of death)

- Can you tell me if X is going up or down during the period of . . . ?

- Why does X go up and down from year to year . . . ?


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“MAYBE” Part I.

- There are advantages to both print and Web publishing.

- Perhaps only a minority of users need the printed version:

- state offices- local health departments- libraries or other reference environs


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And Now a Word About the Future

(If “WDQS” is “a Word”) Will Web-based Data Query Systems supplant annual vital statistics compendiums?

- In terms of data or statistical tables, it is completely possible.

- Think of the users who need the one number, the rank, the rates, etc.


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Will WDQS supplant annual vital statistics compendiums? (continued)

- Another question: Is the vital statistician basically a programmer, a technician or an interpreter, relative to the data?

- Think of the users who need the explanations, the “hows,” the “whys”


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- Analysis is the key component:- trend spotting- investigation (e.g., issue du jour)- summarizing results in plain prose- explaining statistical results


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- Analysis is the key component: (cont.)- explaining statistical . . . power,

calculation, limitations,appropriate application, etc.

- explaining history of investigation


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- Analysis is the key component: (cont.)- explaining history of collection- how items are measured- showing which differences are trivial versus important (i.e., significant)


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Another devil’s advocate question: why not utilize other research statisticians, say at state universities, for VS analysis?

- who are getting their hands dirty inthe data?

- whose job is it 24/7 (7.5/5)?


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“MAYBE” Part II.

- VS need to be tied to public health policy, grant activities, local/state needs assessments, programmatic applications, etc. to be effectively used or presented, say in a VS compendium.

- Analysis is your most valuable asset.


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Um, How Do You Do That?

- Pay attention* to what your agency’s programs are using and asking for

- Pay attention* to what your clients (say they) utilize in your compendium

- Survey your clients, if necessary

* Pay attention = serve on committees, talk to program people, scan the news, etc.


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Um, How Do You Do That?

- Be proactive; the days of people simply coming to you because VS data are the only game in town are (long) over

- Listen, liaison, link the data dots- Adapt (evolve) your VS compendium (and

other products) accordingly


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Case Study: How We Did That

- IL Program for Local Assessment of Needs (IPLAN) wanted a data tool kit for local community groups to use to assess key health indicators and determine five-year priorities for intervention

- Part of LHD re-certification- Community groups’ members not data

savvy, let alone public health statisticians


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- IPLAN needs (continued)

- Regarding VS data, we determined:- long-term planning the focus- lots of small numbers issues for

many LHDs- age-adjusted rates, for example,

difficult to comprehend by users


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- Main VS response was data for the IPLAN database but we also adapted our VS compendium:

- dropped YPLL- added premature mortality rates

(PMR)- added multi-year averaging


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- Adapted VS compendium: (continued)- added county comparison tables- added confidence intervals for

selected measures (e.g., IMR)- added explanations, such as

ICD-9/10 comparison


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5 June, 2008Natality example



5 June, 2008

Mortality example



5 June, 2008County comparisons (PMR)



Will County example, Heart Disease PMR:Year Deaths Deaths Crude All ages 0-64 Rate PMR AADR1999 941 149 194.6 33.6 291.72000 926 175 182.2 37.6 273.52001 925 142 172.3 28.8 263.02002 993 174 175.7 33.5 266.42003 972 182 163.5 33.2 246.02004 880 174 141.5 30.3 214.52005 904 185 140.9 31.2 205.7 % Change 1999-2001

to -1% +16% -19% -5% -20% == 2003-2005


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Other Things to Keep in Mind

“MAYBE” Part III.- Don’t forget year-to-year comparability is

a VS compendium strength and don’t neglect your core content.

- The compendium is expected to be the “gold standard” for VS data.

- VS compendiums are not necessarily meant to be the “latest news” but rather the “last word” regarding a statistical year.


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Thank You

Mark FlotowIllinois Center for Health StatisticsIL Dept Public HealthSpringfield, [email protected] site: www.idph.state.il.us

2008 NAPHSIS Annual Meeting Celebrating 75 Years of Excellence Orlando, FL June 1 st – 5 th, 2008...

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